Wrist-drop

Wright s Stain Wrinkle Wrist drop Wristwatches... 

The alimentary symptoms may be overshadowed by neuromuscular dysfunction, accompanied by signs of motor weakness that may progress to paralysis of the exterior muscles or the wrist (wrist drop), and less often, of the ankles (foot drop). Encephalopathy, the most serious result of lead poisoning, frequendy occurs in children as a result of pica, ie, ingestion of inorganic lead compounds in paint chips this rarely occurs in adults. Nephropathy has also been associated with chronic lead poisoning (147). The toxic effects of lead may be most pronounced on the developing fetus. Consequendy, women must be particulady cautious of lead exposure (148). The U.S. Center for Disease Control recommends a blood level of less than 10 p.m per 100 mL for children. 

One of the earliest effects on the nervous system is found in damage to the nerve supply of the hands and feet. Muscle weakness at the wrist and ankle, in fact, may be one of the first things other than the general unwellness that draws the attention of the victim to his/her condition. It occurs as a dragging of the foot (foot drop) or loss of ability to hold the wrist in the horizontal or raised position (wrist drop). There may also be shaking and trembling, and ultimately full paralysis. 

Reproductive effects at the time of the incident included a 44% loss of fetuses in 865 pregnant women (15% expected), and the neonatal death rate increased from 3% to 15%. Reproductive toxicity of MIC has been confirmed in animal studies exposure has caused increased resorptions, reduced pup weight, and reduced neonatal survival. Terato-logical anomalies including wrist drop, everted claw, syndactyly, cleft palate formation, and unequal ribs were observed in rats exposed to concentrations of up to 0.353 ppm during gestation. ... 

Peripheral neuropathy may appear after chronic high-dose lead exposure, usually following months to years of blood lead concentrations higher than 100 mcg/dL. Predominantly motor in character, the neuropathy may present clinically with painless weakness of the extensors, particularly in the upper extremity, resulting in classic wrist-drop. Preclinical signs of lead-induced peripheral nerve dysfunction may be detectable by electrodiagnostic testing. 

Biochemical changes such as increased aminolaevulinate excretion and inhibition of amino-laevulinate dehydrase may be detected in urine and blood, respectively, at blood lead levels of 0.4 to 0.6 mg mL-1. Anemia is a late feature, however. Neurotoxicity may be detectable at blood lead levels of 0.8 to 1.0 mg mL-1. At blood lead levels greater than 1.2 mg mL-1, encephalopathy occurs. Peripheral nerve palsies are rare, and the foot and wrist drop, which were once characteristic of occupational lead poisoning, only occur after excessive exposure and are now rarely seen. Similarly, seizures and impaired consciousness may result from involvement of the CNS. Bone changes are usually seen in children and are detected as bands at the growing ends of the bones and a change in bone shape. 

Diabetic neuropathy may be associated with neuropathic ulcer, ptosis, diplopia, strabismus, loss of deep tendon reflexes, ankle drop, wrist drop, paresthesia, hyperalgesia, hyperesthesia, and orthostatic hypotension (because of autonomic dysfunction). 

Pure TOCP is a colorless liquid (fp, -27°C bp, 410°C). It produces pronounced neurological effects and causes degeneration of the neurons in the body s central and peripheral nervous systems, although fatalities are rare. Early symptoms of TOCP poisoning include nausea, vomiting, and diarrhea, accompanied by severe abdominal pain. Normally a 1- to 3-week latent period occurs after these symptoms have subsided, followed by manifestations of peripheral paralysis, as evidenced by wrist drop and foot drop. In some cases, the slow recovery is complete, whereas in others partial paralysis remains. 

As the disease progresses, the ankle jerk reflex is lost, and the muscular weakness spreads upward, involving first the extensor muscles of the foot, then the muscles of the caff, and finally the extensors and flexors of the thigh. At fins stage, there is pronounced toe and foot drop - the patient is unahle to keep either the toe or the whole foot extended off the ground. When the arms are affected, there is a similar inahUity to keep the hand extended - wrist drop. 

Answer E. The profile of lead toxicity includes decreased heme synthesis, anemia, nephropathy, and peripheral neuropathy, the last leading to foot drop or wrist drop. Garlic breath and watery stools are associated with arsenic poisoning. Chronic gingivitis and loose teeth are features of mercury poisoning. 

S Lead (tap water, j leaded paint i chips, herbal remedies, gas sniffing, glazed j kitchenware, etc.) Acute nausea and vomiting, GI distress and pain, malaise, tremor, tinnitus, paresthesias, encephalopathy (red or black feces) Chronic multisystem effects—anemia (i heme synthesis), neuropathy (wrist drop), nephropathy (proteinuria, failure), hepatitis, mental retardation (from pica), 4-fertility and t stillbirths Decontamination—gastric lavage + dimercaprol (severe) or EDTA or succimer (penicillamine if unable to use dimercaprol or succimer) Children succimer PO... 

CHRONIC HEALTH RISKS cramp-like pains in calf muscles numbness and tingling in feet or hands weakness of legs and feet bilateral footdrop wrist drop paralysis death in high concentrations. 

Chronic lead poisoning Chronic inorganic lead poisoning (plumbism) is much more common than the acute form. Signs include peripheral neuropathy (wrist drop is character-... 

Peripheral motor neuropathy, affeoting mainly the upper extremities, oan cause severe extensor muscle weakness ( wrist drop ). 

Peripheral neuropathy wrist drop, due to radial nerve involvement, is a classic manifestation of chronic lead neurotoxicity. Clinical and experimental studies support the view that lead induces peripheral nerve lesions. Central nervous system the manifestations of saturnine encephalopathy include headache, irritability, insomnia, apprehension, confusion, nightmares and fits. High exposure levels (at least 200/ig Pb/lOOml in children and 500)Ltg Pb/lOOml in adults) are usually found. Recovery from encephalopathy is often incomplete, and residual neurological damage is frequent. 

Greco-Roman era to 600 CE and later Abdominal colic, motor peripheral paralysis with foot and wrist drop, seizures, death Chronic lead poisoning with chronic encephalopathic and peripheral neuropathic features Pb chronic Gl effects Paul of Aegina Seventh century Major (1945) Nriagu (1983a,b)... 

Later peripheral 60-80+ Wrist drop, foot drop... 

John Jessup Milnes lived in Dalton, a small English town just outside of Huddersfield. He was married, had six young children, and worked as a lawyer in Huddersfield. In July 1881, Milnes was stricken with a violent colic of unknown origin from which he quickly recovered. A few months later in September, his illness returned with a vengeance. He was first attacked [with] wrist drop. Then he lost almost entirely the use of his arms, his brain was affected, and at one time his life seemed in peril. Milnes was eventually diagnosed with lead poisoning. Although... 

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